Increasingly, women who have cancer in one breast are electing to have the other, healthy breast removed as a precaution against future risk. Now, a new study from the Mayo Clinic in Minnesota reveals that the majority of these women are "at peace with their decision" and do not have any long-term regrets.
The topic of elective double mastectomy is a controversial one. When Medical News Today published the results of a study that concluded double mastectomy is not necessary for most women - after finding that 70% of women who opt for this procedure did not have a family history or a positive genetic test for the risk genes - several readers weighed in on the debate.
The bottom line is that it is an emotional subject. Most of us will be touched by breast cancer in some form, whether through personal experience or that of a loved one. According to the Centers for Disease Control and Prevention (CDC), 220,097 women and 2,078 men in the US were diagnosed with breast cancer in 2011 alone.
Researchers from this latest study, published in the journal Annals of Surgical Oncology, note that women with breast cancer have many decisions to make: lumpectomy followed by radiation, having one or both breasts removed, or, after mastectomy, whether to undergo breast reconstruction.
They note that there is mixed data on whether breast cancer patients who opt for a double mastectomy live longer than those who do not, and they add that most studies suggest they do not live longer.
To gauge how women with unilateral breast cancer (cancer in one breast) and family histories of the disease who opt for double mastectomies feel about their decision, the researchers - led by Dr. Judy Boughey, a Mayo Clinic breast surgeon - surveyed 621 of these women who underwent their surgeries between 1960-1993.
92% of women were satisfied with their double mastectomy choice
At two points in time, around 10 years and 20 years after their mastectomies, researchers asked the women about their quality of life and satisfaction with their choice.
A decade after their surgeries, 83% of the women were satisfied with their decision, and 84% said they would make the same choice again.
Of these women, around two thirds had breast reconstruction and one third did not, and 73% said they would make the same decision regarding whether to have breast reconstruction surgery or not.
When the women responded to the second questionnaire 20 years after their mastectomies, 92% said they were still satisfied with their choice.
Interestingly, the team found that while most women were happy with their decision whether it involved breast reconstruction or not, those who did not elect to have reconstructive surgery were more likely to say they would choose to have a double mastectomy again.
Commenting on their findings, Dr. Boughey says:
"I think what this study does is adds some literature to the hands of the people counseling patients to say, 'Whatever decision you make, you're very likely to be happy with that in the long run, so listen to yourself, and make the decision that's best for you.'"
She further explains their findings in the video below:
'Anxiety drives removal of other breast'
Although overall, most women who had breast reconstructions were at peace with their choices, women from this group who needed additional operations because of complications or other reasons were more likely to regret their double mastectomy.
And most women in the group that opted to forego reconstructive surgery felt the same about themselves and their femininity in the long run, and would make the same decisions today, the researchers found.
However, there was slightly more reported satisfaction with appearance, higher self-esteem and feeling more feminine from the group that had reconstructive surgery.
Dr. Boughey speaks of some of the reasons driving the decision to undergo prophylactic mastectomy:
"When we're counseling women considering having the other breast removed, it's a very complex and multilayered discussion. Obviously the risk of developing a new cancer in that breast has to be part of that discussion, but the literature shows that the risk for the other breast is really not that high, and that from a medical standpoint we don't need to recommend that approach.
But it's also important to note that much of what drives removal of the other breast is patient anxiety, which feeds into patient quality of life, and it is also important to consider breast symmetry from a cosmetic standpoint."
MNT recently reported on a study that suggested having a mastectomy for early-stage unilateral breast cancer is not linked to a lower risk of death than breast-conserving therapy plus radiation, despite an increase in the number of women opting for the surgery.